6 Combat HIV/AIDS, malaria and other diseases

Where we are?

The HIV prevalence rate in Tajikistan, according to registration as of 31 December 2012, is 50.7 per 100,000 population. According to experts estimate, the true number of people living with HIV/AIDS in Tajikistan is currently 12,759 people. Although among the HIV-infected, only 74.6% of HIV cases are recorded for men and 25.4% for women. In 50.4% of the registered cases, HIV was transmitted through IDUs, in 31% - through sexual contact, in 2.05% - from mother to child, whereas for 16.6% of other cases the transmission mode was not identified (National statistical data, 2012).

In Tajikistan, ongoing monitoring of the HIV epidemic is carried out on the basis of epidemiological surveillance of reported HIV infection cases and sentinel surveillance (SS). According to recent SS, HIV prevalence among IDUs has a steady decreasing tendency in the past years – 19.4% in 2007, 17.6% in 2008, 17.3% in 2009 and 13.5% in 2011. Furthermore, the large-scale awareness-raising activities among all targeted groups show the impact on behavior change of at-risk groups and general population as a whole. The 2011 BSS among IDUs revealed that 93.5% of IDUs (compared to 69% IDUs in 2010) used sterile injecting equipment the last time they injected. Noteworthy: the first appropriate BSS among MSM (N350) was conducted in 2011 within the extent of Dushanbe city and nearby areas. According to the BSS HIV prevalence among MSM comprised 1.5%. At the same time, 64.9% MSM indicated the use of condoms in the last 6 months.

The coverage of antiretroviral therapy (ART) has doubled from 2008 (376) to 2012 (828). According to official statistics, the coverage of HIV-infected pregnant women by ARV prophylaxis programmes to reduce the risk of mother-to-child HIV transmission has more than twofold increased in the period of 2008-2012.

The Government of Tajikistan, in close cooperation with local public organizations, has been implementing programmes aimed at enhancing universal access to HIV prevention among groups at highest risk and the general population, as well as programmes for treatment and care of the needy.

The reasons for the increase of HIV/AIDS epidemics are due to various geographical, economic, cultural, social and medical factors. They are varied and include: the close proximity of Tajikistan to Afghanistan resulting in increase of drug trafficking through Tajikistan and of IDU numbers. Economic difficulties are leading to unemployment and a consequent increase in number of labor migrants and SWs. High level of stigma and discrimination and low knowledge of HIV/AIDS prevention are the main barriers for people living with HIV/AIDS (PLWHA) and high risk groups to access treatment, care, testing and counseling services.

TB:

Tuberculosis constitutes a serious problem for the country and communities. In Tajikistan annually 6,000 to 8,000 new registered cases of tuberculosis are detected and it’s a growing trend. In 2012, the incidence rate reached 80 per 100,000 population. High treatment success rate achieved 80% among newly detected cases in 2012. One of the serious challenges of the National Program is a high rate of multi-drug resistant (MDR)-TB, 16.8% among new cases and 61.6% among previously treated TB patients, as well as a growing trend of HIV infected patients among TB patients.

UNDP has provided sound technical support in development of the National TB Control Programme for 2010-2015 that was endorsed by the Parliament of Tajikistan. Technical assistance was also provided in developing the implementation objectives of the National Programme as well as in strengthening the capacity of the Government‘s health structures. Only in 2012 over 400 specialists of PHC and TB centers were trained inside the country as well as outside. Extensive technical assistance was provided to implement and strengthen TB activities as well as TB/HIV, MDR-TB, PAL and other components of the National TB Control Programme. So far, over 50 technical documents were developed in the areas of TB control, MDR-TB, TB/HIV, infection control, Laboratory, drug management etc.

Special attention was given to the involvement of civil society organization in implementing activities focused on TB prevention, diagnosis and treatment in communities, through contracting local and international NGOs. Considerable improvements are achieved in directly observed treatment of TB and MDR-TB patients using the network of community volunteers, particularly in remote areas where access to health services is limited.

Today, with support of UNDP, TB patients in all districts and regions of the country are ensured with universal access to TB diagnosis and treatment. Other achievements include strengthened TB laboratory network, infrastructure development, successful implementation, TB/HIV and community DOTS and MDR-TB programmes.

Malaria:

In Tajikistan, malaria reached its peak in 1997 with about 30,000 registered cases. Given the complex epidemiological situation in early 2000s, based on the Tashkent Declaration «Forward from malaria control to elimination» signed by Tajikistan in October 2005, which underlined its political commitment to the elimination of malaria, the Government adopted a «Programme to combat tropical diseases (malaria) in the Republic of Tajikistan for 2006-2010”.

In the course of its implementation, the interventions aimed at reducing malaria morbidity, its containing within the country and preventing the restoration of transmission in areas where malaria had been eliminated earlier.

As a result of these interventions, the situation with malaria in Tajikistan has considerably improved in recent years. In 2012, only 33 malaria cases were registered, which is by 45 cases or 57.7% less than for the same period of last year and almost 1,000 times less than in 1997.

Intensive malaria vector control in the implementation of the National Malaria control programme in Tajikistan for 2011–2015 has led to a sharp reduction in its incidence and a total eradication of the local cases of tropical malaria in the country since 2009.

The major factors negatively affecting the malarial situation and achieving the MDGs in Tajikistan are the growing intensity of malaria transmission in areas adjacent to the Afghan-Tajik border, inadequate access of the population to quality primary health care, lack of insecticides and a limited amount of anti-larval activities. In addition to this, there is a lack of information about the malaria situation in Afghanistan.HIV: